Duke Clinical Research Institute, Durham, NC 27705, USA.
Am Heart J. 2011 Jan;161(1):76-83.e1. doi: 10.1016/j.ahj.2010.10.001.
national initiatives have reduced door-to-balloon (DTB) times for direct-arrival ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). However, STEMI patients requiring interhospital transfer for primary PCI are often excluded from public performance assessments of this quality metric.
we compared DTB time improvements between 2005 and 2007 for 29,248 transfer (25%) and 86,382 direct-arrival STEMI patients treated with primary PCI at 790 hospitals in the National Cardiovascular Data Catheterization PCI Registry. Among the 165 hospitals that submitted data for ≥10 patients per year, we examined the correlation between hospital-level changes in transfer and direct-arrival DTB times.
although DTB times decreased significantly over time for both groups, transfer STEMI patients had longer DTB times (median 149 vs 79 minutes, P < .0001), few received PCI ≤90 minutes (10% vs 63%, P < .0001), and the adjusted rate of DTB time improvement was slower (5% vs 9% relative decrease per year, P < .001) compared with direct-arrival patients. Larger annual transfer volume (not necessarily for primary PCI) was associated with greater improvement in transfer DTB times. However, there was no correlation between hospitals that improved direct-arrival DTB times and those that improved transfer DTB times (r = 0.094, P = .23).
although there has been modest temporal improvement in DTB times, transfer patients still rarely achieve benchmark standards. Hospitals that had greater improvements in direct-arrival DTB times were not necessarily those with greater improvements in transfer DTB times. These results highlight the need for targeted system and policy approaches to improve DTB time for transferred primary PCI patients.
国家倡议已经减少了直接到达 ST 段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗（PCI）的门球时间（DTB）。然而，需要进行医院间转院的 STEMI 患者通常被排除在公众对这一质量指标的绩效评估之外。
我们比较了 2005 年至 2007 年期间，在全国心血管数据经导管 PCI 注册中心的 790 家医院接受直接到达的 86382 例和接受医院间转院的 29248 例 STEMI 患者行直接 PCI 治疗的 DTB 时间改善情况。在所提交数据中每年每例患者至少有 10 例的 165 家医院中，我们检查了医院间转院和直接到达 DTB 时间变化之间的相关性。
尽管两组的 DTB 时间都随着时间的推移显著下降，但转院 STEMI 患者的 DTB 时间更长（中位数 149 分钟 vs. 79 分钟，P<0.0001），很少有患者在 90 分钟内接受 PCI（10% vs. 63%，P<0.0001），调整后的 DTB 时间改善率较慢（每年相对下降 5% vs. 9%，P<0.001）与直接到达的患者相比。更大的年度转院量（不一定是直接 PCI）与转院 DTB 时间的改善相关。然而，改善直接到达 DTB 时间的医院与改善转院 DTB 时间的医院之间没有相关性（r=0.094，P=0.23）。
尽管 DTB 时间已经有了适度的时间改善，但转院患者仍很少达到基准标准。直接到达 DTB 时间改善更大的医院不一定是转院 DTB 时间改善更大的医院。这些结果突出表明需要采取有针对性的系统和政策措施来改善转院接受直接 PCI 治疗的患者的 DTB 时间。
